Transient Loss of Consciousness Interview Flashcards
Describe reflex syncope
Vasovagal
Situational
- Cough
- Micturition
What are some reasons for a cardiac syncope?
Arrythmias - Tachycardia - Bradycardia Structural disease - Aortic stenosis - Myocardial ischaemia
What are two reasons for orthostatic hypotension?
Primary autonomic failure Secondary autonomic failure - Diabetes Drug induced - Diuretics - Vasodilators
Do you have to establish if there was true loss of consciousness?
Yes
What are some conditions that could be mixed up for TLOC?
Vertigo
Disequilibrium
Pre-syncope
Non-specific dizziness
What is the prodrome for vasovagal syncope?
Usually present
Includes feeling of light-headedness and “wobbly” legs, vision going dim, noises sounding distant
May remember start of collapse
What is the prodrome for cardiac syncope?
Usually not present
What is the prodrome for seizure?
Generalised and focal seizures may be preceded by prodrome
Focal seizures may have an aura – nature depends where seizure originates in brain
Focal seizures can become generalised
Is site relevant for TLOC?
No
What is the quality of vasovagal syncope?
Loss of postural tone
Convulsive movements can occur – only a few jerks
What is the quality of cardiac syncope?
Loss of postural tone
Convulsive movements can occur – only a few jerks
What is the quality of seizure?
(i) Tonic phase – stiffening of limbs with extension of back and limbs, eyes deviate upwards, may cry out involuntarily
(ii) Clonic phase – generalised flexion contractions of muscles alternating with relaxation
Is severity quantified for TLOC?
No
What is the time course for vasovagal syncope?
Usually less than 30 sec
What is the time course for cardiac syncope?
Usually less than 30 sec
What is the time course for seizure?
Usually 1-2 min
What is the context of vasovagal syncope?
Usually doesn’t occur when sitting/lying
What is the context of cardiac syncope?
Can occur when sitting/lying
What is the context of seizure?
Can occur when sitting/lying
Can occur during sleep
What are the precipitating factors for vasovagal syncope?
Fasting
Pain
Emotional events
Prolonged standing
What are the precipitating factors for cardiac syncope?
Doesn’t have clear precipitating factor
Can occur on exertion
What are the precipitating factors for seizure?
Usually spontaneous but can be triggered by sleep deprivation/stress
What are the relieving factors for vasovagal syncope?
Lying flat assists recovery
What are the relieving factors for cardiac syncope?
Self-limiting
What are the relieving factors for seizure?
Self-limiting
What are the associated features of vasovagal syncope?
Tongue biting unusual Head turning unusual Sweaty Pallor No cry/moan No frothing at mouth Incontinence of urine may occur, although not common
What are the associated features of cardiac syncope?
Tongue biting unusual Head turning unusual Sweaty Pallor No cry/moan No frothing at mouth Incontinence of urine may occur, although not common May be associated with exertion/palpitations
What are the associated features of seizures?
Tongue biting common Head turning common Usually not sweaty Cyanosis Cry/moan at onset Frothing at mouth Incontinence of urine may occur
What happens after a vasovagal syncope?
Rapid recovery of consciousness
Rarely confused afterwards
Injury not common as protective reflexes preserved
What happens after a cardiac syncope?
Rapid recovery of consciousness
Rarely confused afterwards
Injury may occur
What happens after a seizure?
Slow recovery Period of confusion >2 min May feel exhausted and sleepy Muscle aches Injury common
What specific medical history questions do you ask for vasovagal syncope?
Hydration status
Autonomic dysfunction
What specific medical history questions do you ask for cardiac syncope?
Cardiac disease
What specific medical history questions do you ask for seizure?
Have you had a seizure before?
